The Stryker notch view is a specialized projection of the shoulder, aimed at assessing the posterior humerus.

Indications

The Stryker notch view can be used post anterior glenohumeral dislocation, assessing for Hill-Sachs defects ¹.

Patient position

• the patient is preferably erect
• the mid-coronal plane of the patient is parallel to the image receptor: the patient's back is against the image receptor
• the glenohumeral joint of the affected side is at the center of the image receptor
• the patient is turned toward the affected side to show the glenohumeral joint space; this is achieved by rotating the patient 30-45°
• affected arm is abducted anteriorly and rested on the patient's head while maintaining internal rotation (if possible)

Technical factors

• anteroposterior inferosuperior axial projection
• centering point
  • 10-15° cephalad angle of the x-ray tube
  • mid-axilla at the level of the glenohumeral joint 
• collimation
  • superior to include the entire neck of the humerus 
  • inferior to include the glenoid 
  • lateral to the extent of the humeral head 
  • medial to the extent of the humeral head 
• orientation  
  • portrait
• detector size
  • 18 cm x 24 cm
• exposure
  • 60-70 kVp
  • 10-18 mAs
• SID
  • 100 cm
• grid
  • yes (this can vary departmentally)

Image technical evaluation

• the glenohumeral joint should be open
• the humerus is pointing superiorly 
• the lateral portion of the humeral head should be free from any superimposition 

Practical points

• it is important to demonstrate to the patient how this projection needs to be performed
• set the patient up (similar to an AP glenoid projection), then ask the patient to abduct the arm and place it on their head
• tight collimation avoids any unwanted scatter
• rotation of the patient will vary due to body habitus: this is an obvious point but highly relevant
  • patients who require these films are often suffering from either chronic or acute shoulder pain and palpating the affected shoulder is far from ideal
  • it is advisable to observe the clavicle when rotating the patient until the midshaft of the clavicle is almost end on